Becoming and remaining open defecation free: a case study in Eastern Uganda

Abstract

Poor sanitation, including open defecation, presents risk for diarrhea, which is responsible for 7.1% of mortalities in children under age five each year in Uganda. Although the implementation of the Community-led Total Sanitation (CLTS) intervention is successful at ending open defecation, more than half of the investment in producing open defecation free (ODF) communities is lost during the maintenance phase. This case study sought to understand the barriers and facilitators to becoming ODF and maintaining ODF certification in a community located in Eastern Uganda. Individual interviews with CLTS practitioners and focus group discussions with community members gathered key findings suggesting recommendations for CLTS practitioners. These recommendations include providing access to latrine construction tools, offering instructions for locating durable materials, using supportive rather than punitive intervention methods, demonstrating the dangers of open defecation (OD) and the benefits of being ODF, stacking programs with integrated, holistic teachings and promoting successful community stakeholders as ambassadors. In addition to quality of life and public health benefits, this research suggests that social outcomes, such as self-efficacy, growth, and generativity resulting from a supportive, holistic effort, may well move communities beyond the maintenance phase to engage in future community development efforts promoting further advancement and flourishing.